Occupational therapy Part I- Status quo in Austria and Part II- Occupational therapy for rheumatoid arthritis

 

Project leader: Brigitte Piso
Project team: Ines Schumacher, Brigitte Piso
Duration: May 2011 - May 2012
Language: German
Publication: LBI-HTA Project Report No. 56:  http://eprints.hta.lbg.ac.at/972/


Part I
Background
There are different definitions describing “occupational therapy”. According to the World Federation of occupational therapists, occupational therapy “is a profession concerned with promoting health and wellbeing through occupation. The primary goal is to enable people to participate in the activities of everyday life”. These outcome will be achieved by “enabling people to do things that will enhance their ability to participate or by modifying the environment to better support participation” (WFOT, 2004). Occupational therapy is primarily used in pediatrics, psychiatry, neurology, geriatrics and orthopedics. Services are provided in inpatient care (e.g. in psychiatric, rehabilitation or support of mentally or physically disabled people). For outpatient care, occupation therapy must be described by a general practitioner. Most of the service is provided by “Wahlergotherapeuten”. Cost of treatment are reimbursed by the social insurance on a pro-rata basis.

Aims of project
To give an overview of the current conditions of occupational therapy in Austria (education, type and number of services provided, number of therapists).

Research objectives

  • How is the education/study for occupational therapists organized?
  • Which target groups get (what kind of) service?
  • How many occupational therapists are working in Austria and to what extend are services provided (including trends)?
  • How can the services of physiotherapy be differentiated?

Methods
non-systematic literature research, interviews, data from occupational therapists and social insurance.

Part II
Background
Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder of the connective tissue that principally attacks flexible (synovial) joints. About 1% of the population is affected by RA. Treatment of RA is complex and includes pharmacological, physical, occupational orthopaedic and psychological therapy. Occupational therapy interventions include for example advice and instruction in the use of assistive devices, provision of splints, instruction on joint protection or training of self care activities.

Aim of project
The projects aims are assessing the evidence concerning the efficacy of occupational therapy for rheumatoid arthritis.

Method
Systematic literature search in various databases (Cochrane, CRD, Embase, Medline, OT-Seeker) will be supplemented by non-systematic hand-search.
The systematic review will use the most recent Cochrane review on occupational therapy for rheumatoid arthritis as starting basis for investigation. It uses the predefined categorisation of occupational therapy interventions and the search strategy and will add results of RCTs published since 2003 to previous Cochrane results.

PICO-question
Are occupational therapy interventions for patients with rheumatoid arthritis more effective concerning pain and fatigue reduction as well as increasing functional abilities (including dexterity), quality of life and grip force than no/ other intervention(s) or routine care?
Inclusion criteria

Inclusion criteria

Population

b       Patients with rheumatoid arthritis
b       ≥18 years
Intervention(s)occupational therapy provided by an occupational therapist 
b       comprehensive occupational therapy
b       training of motor function
b       training of skills
b       instruction on joint protection
b       counselling 
b       advice and instruction in the use of assistive devices
b       provision of splints
Controlb       no intervention
b       routine care (incl. standard occupational therapy)
b       other interventions
Outcomesb       pain
b       functional ability (including dexterity)
b       quality of life (incl. Well-being and depression)
b       “fatigue”
b       grip force
Study designb       randomised controllied trials (RCTs)
b       cross-over-studies

Exclusion criteria

  • Children and adolescents aged ≤18 years
  • patients with juvenile idiopathic arthritis
  • patients with rheumatoid arthritis and other diseases (multimorbidity)
  • comparison of devices of different manufacturers
  • Studies with multi-disciplinary interventions (programmes, delivered by occupational therapists in collaboration with other professions e.g. physical therapists, psycologists)
  • systematic reviews, metaanalyses
  • non-randomised, controlled studies and uncontrolled studies
  • case-series, case reports
  • expert opinion
  • cost-effectiveness studies 

Time schedule/ milestones
Part I
May 2011: Project protocol, non-systematic literature search, contact with experts
June-September 2011: drafting of report
February 2012: internal and external review
hand search,
November 2011: Data extraction, , internal review
December 2011: External review, publication

Part II
November 2011: Project protocol
December 2011: systematic literature search, non-systematic hand search, ordering of literature, literature selection
Devember 2011-January 2012:, data extraction, drafting of report
February 2012: internal and external review

 

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